Pre-Registration is preferred. On-line registration is below.You will receive a confirmation when your information is submitted.

* Indicates required field

Participant's Name *

First

Last

Gender *

MaleFemale

Age *

Birthdate *

MM-DD-YYYY

School Grade Entering 2018-19: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Mother's Name *

First

Last

Father's Name *

First

Last

Home Phone Number *

Mother's Cell Phone Number *

Father's Cell Phone Number *

Email *

Person/s allowed to pick up child/ren: *

Photo/Video Permission *

By selecting from the dropdown menu, I give/do not give authorization for the participant listed above to have photos taken during Divine Street UMC activities, to have photos used in printed materials, to have photos posted, used in electronic communications including the internet, website and email, and to have videos taken during Divine Street UMC activities to be used in public forums including events, internet and television. No names will be used.